"Created" patella in total knee arthroplasty (TKA) after prior patellectomy

Currently, total knee arthroplasty (TKA) is one of the most successful orthopaedic surgeries. However, the results are inferior in patients with previous patellectomy because of anteroposterior instability, residual pain, and loss of the mechanical advantage of the patella. The moment arm of the quadriceps can be restored by bone grafting the patellar tendon, and thus regaining the benefits of an intact patella that results in a better outcome after TKA. Usually it requires an additional procedure with its associated co-morbidities to harvest the bone graft. As the bone graft has to articulate with the femoral prosthesis, it has to be smooth at least on one side. The authors have described a new technique in this Chapter by which bone grafting of the patellar tendon can be achieved with use of the tibial plateau obtained from the routine tibial cut during TKA. Tibial eminence can be used as the interfacetal ridge of the "created" patella.